Palliative Medicine: More Than Just Morphine (Part III of III)

As with everyone else, cancer patients have families, loved ones, who care for them, appreciate them, and each carry their own responsibilities. Some are single parents, sole breadwinners, have young kids or elderly parents to care for. Being progressively unwell, their duties become more difficult to carry out, they become more dependant and frustrated. Life becomes unmanageable and before the dynamics could change properly, it all is too late.

A good physician would be able to assess the psychosocial issues and help the families shift the family dynamics to be able to cope with the disease. As one who have seen other patients deteriorate, the attending physician should be able to guide the patient and family regarding the natural history of the disease and what it would mean to their lives. They may have realized that advanced cancer is almost always fatal but may not be aware of the process of dying.

Again, it is crucial for the medical practitioner to get a proper history and establish a good rapport with the patient and family to be able to gain insight and trust from them. It would be worthwhile for the attending physician to spend time listening to the patient and their concerns, or even their life stories which may not seem relevant at that time, to be able to see life at their perspectives. This may only be achieved in more than one sitting, and more importantly, not to be done while standing at the hospital corridors.

Another important aspect of palliative care is the spiritual health of a patient. As cancer progresses, one becomes more dependant and will inevitably make them question the meaning of his life. Cancer has been described as isolating, and this intractable loneliness would affect their mental health as well as their quality of life.

Some patients may have deep spiritual roots that they could face the trials life throws at them with such strength and calmness. Some others may need more help and attention for them to be able to spend their remaining time in a meaningful manner. It may involve delving deeper into their past life – their love, regrets, passion or guilt, which brings us back to the significance of a good rapport with the patient.

Seeing the nature of this field and the natural history of advanced cancer, it would be crucial to incorporate palliative care early in cancer management. A shift from cure versus comfort care, to involvement of symptom control at the time of diagnosis (even when the disease is curable), has been suggested. There would be more time to build rapport and maintain it as treatment is applied. Patients would feel more supported through their journey, hence improving their quality of life, making their experience less isolating and more meaningful, even for the attending medical practitioners.

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Editorial

The newly minted Health Minister, Dr Dzulkefly, has announced the setting up of an advisory council for the Health Ministry to help with charting the future direction of healthcare. It will likely be a mix of experience and youth as we barrel towards to a new decade.